Li M, Hu H, Tong SX, et al. The Therapeutic Efficacy of Pulsed Radiofrequency Alone Versus a Dexamethasone and Pulsed Radiofrequency Combination in Patients With Trigeminal Postherpetic Neuralgia: A Double-blind, Randomized Controlled Trial. Pain Physician. 2022 Jul;25(4):E543-E549. (Original study)

BACKGROUND: Pulsed radiofrequency (PRF) of the Gasserian ganglion is a common surgical intervention used to treat trigeminal postherpetic neuralgia (PHN). Dexamethasone has been reported to possess anti-inflammatory effects and potential analgesic benefits.

OBJECTIVES: The primary objective of our study was to compare the therapeutic efficacies of PRF alone versus a combination of PRF and dexamethasone for trigeminal PHN.

STUDY DESIGN: A prospective, double-blind, randomized controlled trial.

SETTING: Department of Pain Management, Wuhan First Hospital.

METHODS: A total of 103 patients diagnosed with trigeminal PHN were randomly assigned into 2 groups (the PRF group and PRF plus dexamethasone [PRF+D] group). Digital subtraction angiography-guided puncture of the Gasserian ganglion was performed. All patients received PRF of the Gasserian ganglion first, and then a local injection was administered into the Gasserian ganglion. Patients in the PRF+D group received PRF therapy and one mL of 5 mg dexamethasone in the Gasserian ganglion, while patients in the PRF group received PRF therapy and one mL of normal saline in the Gasserian ganglion. The primary outcome was pain intensity, measured by the visual analog scale (VAS). The secondary outcome was quality of life, assessed by the Short Form-36 questionnaire (SF-36). The dosage of pregabalin administered was recorded to assess treatment effectiveness.

RESULTS: Compared with the PRF group in this study, the PRF+D group showed more promising outcome results in pain relief as measured by the VAS; quality of life enhancement, as measured by the SF-36; and a reduced requirement for antiepileptic drugs (P < 0.01).

LIMITATIONS: Single center study, relatively small number of patients.

CONCLUSIONS: The therapeutic efficacy of PRF combined with a dexamethasone injection into the Gasserian ganglion was superior to that of PRF{and saline injection} alone of the Gasserian ganglion for trigeminal PHN.

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Comments from MORE raters

Physician rater

This prospective study compares direct pulsed radiofrequency with or without dexamethasone in trigeminal post-herpetic neuralgia. There is a barely significant improvement when dexamethasone is injected at the time of the pulse. Pulsed radiofrequency is not considered first or second line for post-herpetic neuralgia and its results have been mixed in other studies. In the circumstance where it is considered for a patient with post herpetic trigeminal neuralgia, dexamethasone may augment its effect.

Physician rater

A study with a good methodologic design: prospective, randomized, double-blinded, controlled, was presented to the ethics committee and had clear diagnostic criteria and adequate follow-up. It describes the intervention for the 2 treatment groups, without severe complications, but with a small number of cases and better results in the group with dexamethasone.

Physician rater

Corticosteroids are actually used to treat postherpetic neuralgia, and pulsed radiofrequency is new therapy for trigeminal postherpetic neuralgia.

Physician rater

This is not a condition encountered often in practice. Also, pulsed radio frequency is not something that is routinely used in the internal medicine or hospital setting. This may be more useful to a pain specialist. The findings are similar to other studies that have used it in trigeminal neuralgia
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